Lifestyle changes are the best way to fight obesity

Rx for exercise

Dr. Ifekan-Shango Simon of the Spartanburg (S.C.) Regional Healthcare System does a 15-minute workout with Chrissy Stepp, LPN. With the help of
Simon, Stepp has lost more than 50 pounds and has kept it off for more than three years.

John Byrum/Halifax Media Group

By DUSTIN WYATTHalifax Media Group

Published: Wednesday, July 17, 2013 at 4:30 a.m.

Last Modified: Tuesday, July 16, 2013 at 10:59 a.m.

Dr. Ifekan-Shango Simon writes a lot of prescriptions these days.

Not all are for medication or pills.

Simon, a family physician at Spartanburg (S.C.) Regional Healthcare System, writes what he calls "exercise prescriptions" as well.

He gives these to patients who have a body mass index of more than 25 — categorized as overweight or obese.

"Here, try this," he will say.

"I don't tell patients to take medications to lose weight," he said, seated in a fitness center on a recent Thursday. "Medicine is not the answer. It's a lifestyle change. For the majority of us, exercise, how we eat, making changes in our life can make the most difference."

Obesity is now recognized as a disease by the American Medical Association.

It's a disease that afflicts 32 percent of adults in Spartanburg County, and almost half of Spartanburg fifth-graders.

National health leaders say the AMA's declaration will have a significant impact in adding momentum to policy, research and treatment approaches to obesity, according to a recent article by American Medical News.

Kate Crosby, spokesperson for the South Carolina Medical Association, said the organization has been working diligently over the past several years through its SCMA Childhood Obesity Taskforce to increase the recognition of obesity as not only an epidemic but also as a medical illness that needs collective attention.

"Statewide initiatives such as the one being led by DHEC Director Catherine Templeton and recognition of it as a disease by the AMA and DHHS really illustrates that our state and our nation are coming together in the fight against obesity," Crosby said in a statement.

But Simon, who serves as assistant professor to the hospital's many residents, said it doesn't change the way he treats patients who are overweight or obese.

He's always written "fitness prescriptions."

"It's no change for me," he said. "I encourage people to get to a healthy weight. If I see patients who are overweight, if exercise or eating right will improve their health, then that is what I recommend."

Doctors help patients shed pounds

Simon sees about 12 patients each day, and nearly half are overweight or obese, he said.

He writes a lot of these "fitness prescriptions," and each is patient-specific.

He realizes some obese and overweight patients are "too heavy" to use treadmills and some workout equipment. Some develop leg and knee pain when they walk short distances. Others simply can't afford a gym membership.

So when patients who really want to try to lose weight are in Simon's office, he writes them an exercise program.

He asks, "What can you do? What is keeping you from exercising the way you would like to? What do you have in your home?"

He often suggests for people younger than 40 that they use what he calls "the invisible jump rope" — a device he demonstrated recently.

It's free, he quipped, as he jumped up and down, his arms moving in a circular motion.

"You can use it anywhere. It's easy to use," he said.

He tells patients to swing the invisible jump rope around and take small jumps or big jumps whenever they can — when they are watching television, while they are working. Even those who are morbidly obese and use wheelchairs can repeatedly lift their rear ends off their seats as the invisible jump rope passes under them.

"If you use the invisible jump rope to the count of 20, you will feel it work," he said.

The South Carolina Medical Association says now that obesity is declared a disease, we can expect more doctors to devote more intensive clinical attention to obesity and help their patients move in the right direction for a healthier, longer life.

"At the same time, addressing patient responsibility is vital for addressing the national obesity problem. A physician's best treatment combined with a patient who doesn't change their lifestyle won't work," Crosby said.

Simon says he takes exercise seriously. He spends a lot of time in the fitness center at the hospital. He often takes bike rides. He even offers to go with patients to a pool or fitness center.

"If you really want to exercise, meet me," he will say.

"I want my patients to be committed," he said on a recent Wednesday. "And I want them to pass the word around how easy it is to exercise. It's amazing how much can be done that you can easily do."

Step in right direction

While declaring obesity as a disease might not have as much impact on doctors, it could potentially benefit obese patients.

Dr. Caroline Dy-Go, a pediatric nutrition specialist and member of the Spartanburg Medical Society, said the recognition of obesity as a disease by the American Medical Association could help pave the way to cover physician visits, nutritional services and exercise programs needed to address the growing obesity epidemic.

Dr. Jason Johnson, a bariatric surgeon at Spartanburg Regional Healthcare System, said the declaration is a huge step in the right direction.

"What is the difference between obesity and diabetes?" he asked. "Obesity is a whole lot less socially acceptable. Now more of the medical societies are going to be educating the general public about obesity. It's a disease. People think it's a lifestyle, but if you weigh 300 pounds, and you try to lose weight, you can't."

For these patients, their only viable option might be weight-loss surgery.

Johnson performs about six to 10 procedures a week, he says.

It's a recommendation doctors, such as Simon, sometimes have to make if their first recommendations aren't working.

"For a person who sincerely tried exercising and diets, and their weight is at such an extreme, I will recommend weight-loss surgery," Simon said.

Johnson calls it a last resort, but by no means is it an easy way out.

"By the general public, it's seen as a weakness, as a failure, but once a person is obese, there is really no effective way to get that weight off," he said. Weight-loss surgery is "actually the harder way of doing it. It's having your stomach stapled off, it's having your intestines rerouted. There are significant amounts of risk in that," he said.

Patients have to go through a three-month process before the surgery is even done, he said. They go to lectures about varying procedures, and they speak with dieticians and nurse practitioners about pre-surgical, weight-management programs.

"This is to make sure they understand what they are going through and they understand what their diet is going to be like," Johnson said.

They also have to see an eating disorder specialist, and they have to go to educational sessions.

"There is a huge amount that goes into it; it's not just call one day and have surgery the next," Johnson said.

Weight-loss surgery doesn't just help a patient shed pounds, Johnson said. Many patients also no longer have diabetes, high blood pressure and sleep apnea after the surgery as well.

Now that obesity is considered a disease, Johnson said maybe insurers can think about covering procedures that treat it, such as weight-loss surgery.

Simon hopes the classification of obesity as a disease will enable him to eventually write "real" fitness prescriptions — "Maybe insurance will cover gym memberships eventually," he said.

<p>Dr. Ifekan-Shango Simon writes a lot of prescriptions these days.</p><p>Not all are for medication or pills.</p><p>Simon, a family physician at Spartanburg (S.C.) Regional Healthcare System, writes what he calls "exercise prescriptions" as well.</p><p>He gives these to patients who have a body mass index of more than 25 — categorized as overweight or obese.</p><p>"Here, try this," he will say.</p><p>"I don't tell patients to take medications to lose weight," he said, seated in a fitness center on a recent Thursday. "Medicine is not the answer. It's a lifestyle change. For the majority of us, exercise, how we eat, making changes in our life can make the most difference."</p><p>Obesity is now recognized as a disease by the American Medical Association.</p><p>It's a disease that afflicts 32 percent of adults in Spartanburg County, and almost half of Spartanburg fifth-graders. </p><p>National health leaders say the AMA's declaration will have a significant impact in adding momentum to policy, research and treatment approaches to obesity, according to a recent article by American Medical News. </p><p>Kate Crosby, spokesperson for the South Carolina Medical Association, said the organization has been working diligently over the past several years through its SCMA Childhood Obesity Taskforce to increase the recognition of obesity as not only an epidemic but also as a medical illness that needs collective attention. </p><p>"Statewide initiatives such as the one being led by DHEC Director Catherine Templeton and recognition of it as a disease by the AMA and DHHS really illustrates that our state and our nation are coming together in the fight against obesity," Crosby said in a statement.</p><p>But Simon, who serves as assistant professor to the hospital's many residents, said it doesn't change the way he treats patients who are overweight or obese.</p><p>He's always written "fitness prescriptions."</p><p>"It's no change for me," he said. "I encourage people to get to a healthy weight. If I see patients who are overweight, if exercise or eating right will improve their health, then that is what I recommend."</p><p>Doctors help patients shed pounds</p><p>Simon sees about 12 patients each day, and nearly half are overweight or obese, he said.</p><p>He writes a lot of these "fitness prescriptions," and each is patient-specific.</p><p>He realizes some obese and overweight patients are "too heavy" to use treadmills and some workout equipment. Some develop leg and knee pain when they walk short distances. Others simply can't afford a gym membership.</p><p>So when patients who really want to try to lose weight are in Simon's office, he writes them an exercise program.</p><p>He asks, "What can you do? What is keeping you from exercising the way you would like to? What do you have in your home?" </p><p>He often suggests for people younger than 40 that they use what he calls "the invisible jump rope" — a device he demonstrated recently.</p><p>It's free, he quipped, as he jumped up and down, his arms moving in a circular motion. </p><p>"You can use it anywhere. It's easy to use," he said. </p><p>He tells patients to swing the invisible jump rope around and take small jumps or big jumps whenever they can — when they are watching television, while they are working. Even those who are morbidly obese and use wheelchairs can repeatedly lift their rear ends off their seats as the invisible jump rope passes under them.</p><p>"If you use the invisible jump rope to the count of 20, you will feel it work," he said.</p><p>The South Carolina Medical Association says now that obesity is declared a disease, we can expect more doctors to devote more intensive clinical attention to obesity and help their patients move in the right direction for a healthier, longer life.</p><p>"At the same time, addressing patient responsibility is vital for addressing the national obesity problem. A physician's best treatment combined with a patient who doesn't change their lifestyle won't work," Crosby said. </p><p>Simon says he takes exercise seriously. He spends a lot of time in the fitness center at the hospital. He often takes bike rides. He even offers to go with patients to a pool or fitness center.</p><p>"If you really want to exercise, meet me," he will say.</p><p>"I want my patients to be committed," he said on a recent Wednesday. "And I want them to pass the word around how easy it is to exercise. It's amazing how much can be done that you can easily do."</p><p>Step in right direction</p><p>While declaring obesity as a disease might not have as much impact on doctors, it could potentially benefit obese patients.</p><p>Dr. Caroline Dy-Go, a pediatric nutrition specialist and member of the Spartanburg Medical Society, said the recognition of obesity as a disease by the American Medical Association could help pave the way to cover physician visits, nutritional services and exercise programs needed to address the growing obesity epidemic.</p><p>Dr. Jason Johnson, a bariatric surgeon at Spartanburg Regional Healthcare System, said the declaration is a huge step in the right direction.</p><p>"What is the difference between obesity and diabetes?" he asked. "Obesity is a whole lot less socially acceptable. Now more of the medical societies are going to be educating the general public about obesity. It's a disease. People think it's a lifestyle, but if you weigh 300 pounds, and you try to lose weight, you can't."</p><p>For these patients, their only viable option might be weight-loss surgery.</p><p>Johnson performs about six to 10 procedures a week, he says.</p><p>It's a recommendation doctors, such as Simon, sometimes have to make if their first recommendations aren't working.</p><p>"For a person who sincerely tried exercising and diets, and their weight is at such an extreme, I will recommend weight-loss surgery," Simon said.</p><p>Johnson calls it a last resort, but by no means is it an easy way out.</p><p>"By the general public, it's seen as a weakness, as a failure, but once a person is obese, there is really no effective way to get that weight off," he said. Weight-loss surgery is "actually the harder way of doing it. It's having your stomach stapled off, it's having your intestines rerouted. There are significant amounts of risk in that," he said.</p><p>Patients have to go through a three-month process before the surgery is even done, he said. They go to lectures about varying procedures, and they speak with dieticians and nurse practitioners about pre-surgical, weight-management programs.</p><p>"This is to make sure they understand what they are going through and they understand what their diet is going to be like," Johnson said.</p><p>They also have to see an eating disorder specialist, and they have to go to educational sessions.</p><p>"There is a huge amount that goes into it; it's not just call one day and have surgery the next," Johnson said.</p><p>Weight-loss surgery doesn't just help a patient shed pounds, Johnson said. Many patients also no longer have diabetes, high blood pressure and sleep apnea after the surgery as well. </p><p>Now that obesity is considered a disease, Johnson said maybe insurers can think about covering procedures that treat it, such as weight-loss surgery.</p><p>Simon hopes the classification of obesity as a disease will enable him to eventually write "real" fitness prescriptions — "Maybe insurance will cover gym memberships eventually," he said.</p>